Proquilarv - PRODUCTOS QUIMICOS PARA LA INDUSTRIA Y EL HOGAR

Dealers

Please fill the form

General Information

Name of the Applicant *

Business Name *

Identity card *

Activity *

Trade Name *

Date of incorporation *

City *

State/Province *

Name of legal representative *

Phone *

Fax

Business Address *

Storehose Address *

Mailbox

Number of employees *

Legal representative's marital status *

Spouse Name

Address

References

Banks

Commercials

Bank *

Account *

Company *

Phone *

Amount *

Bank *

Account *

Company *

Phone *

Amount *

Bank

Account

Company *

Phone *

Amount *

Contacts

Buyer name *

Buyer email *

Name of the person responsible for payments to suppliers *

person responsible for payments to suppliers´s email *

Days of payment *

hour *

Method of payment *

Check

Transfer

Bank

Retention´s delivey days *